Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015

March 8, 2017

Questions for Anjel Vahratian, Supervisory Statistician (Health) and Lead Author on “Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015

Q: Why did you decide to look at clinical preventive services for cancer and heart disease among insured adults?

AV: Heart disease and cancer are the top two leading causes of death in the United States. The clinical preventive services discussed in this report are recommended for the prevention or early detection of heart disease and cancer. We limited our analysis to insured adults because most insurance plans were required to cover these clinical preventive services without co-payment from the insured adult in 2015.


Q: What did your report find out about cancer screenings among insured adults?

AV: In 2015, two-thirds of insured adults aged 50-75 were screened for colorectal cancer within the recommended intervals, and screening was significantly associated with age for both men and women. Insured women aged 50-59 were more likely to be screened for colorectal cancer compared with men of the same age. Among insured women, more than 8 out of 10 of those aged 21-65 had been screened for cervical cancer, and nearly 3 out of 4 of those aged 50-74 had been screened for breast cancer within the recommended intervals.


Q: What did your report find out about heart disease screenings among insured adults?

AV: In 2015, more than 8 in 10 insured adults aged 18 and over had their blood pressure checked by a doctor or other health professional, and about 2 in 3 overweight and obese insured adults aged 40-70 had a fasting blood test for high blood sugar or diabetes in the past 12 months. Receipt of these services increased with advancing age and varied by sex. Insured women aged 18-39 and 40-64 were more likely than their male peers to have their blood pressure checked in the past 12 months, and insured overweight and obese women aged 40-49 were more likely than men of the same age and BMI to have a fasting blood test or diabetes in the past 12 months.


Q: Was there a specific finding that you found surprising?

AV: It was surprising that only 49.5% of overweight and obese insured men aged 40-49 had a fasting blood test for diabetes in the past 12 months. Diabetic adults are at increased risk of developing cardiovascular disease, and overweight and obesity and abnormal blood glucose are modifiable cardiovascular risk factors.


Q: What is the take home message of this report?

AV: Utilization of clinical preventive services aimed at the early detection of cancer and cardiovascular disease varied by sex and age among insured adults. Insured adults in their 40s and 50s were less likely than those in their 60s to be screened for colorectal cancer, high blood pressure, and diabetes. Limited knowledge about the recommendations for clinical preventive services may prevent eligible adults from seeking out timely preventive care.


Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey

February 23, 2017
Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Questions for Tainya C. Clarke, Ph.D., M.P.H., Health Statistician and Lead Author on the “Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey.”

Q: What health measures does this report look at?

TC: The measures covered in this report are lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure–time physical activity, current cigarette smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma. Three of these measures (lack of health insurance coverage, leisure-time physical activity, and current cigarette smoking) are directly related to Healthy People 2020 Leading Health Indicators.


Q: How do you collect your data for these surveys?

TC: The data is collected by household interview surveys that are fielded continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in respondents’ homes. Health and socio-demographic information is collected on each member of all families residing within a sampled household. Within each family, additional information is collected from one randomly selected adult (the “sample adult”) aged 18 years or older and one randomly selected child (the “sample child”) aged 17 years or younger. NHIS data is collected at one point in time so we cannot determine causation. Data presented in this report are quarterly data and are preliminary.


Q: What are some of the findings that you would highlight in this early release report?

TC: Here are some findings from the early release report:

• The percentage of persons of all ages who had a usual place to go for medical care decreased, from 87.9% in 2003 to 85.4% in 2010, and then increased to 88.3% in January–September 2016.

• The percentage of persons who failed to obtain needed medical care due to cost increased, from 4.3% in 1999 to 6.9% in 2009 and 2010, and then decreased to 4.4% in January–September 2016.

• The percentage of adults aged 65 and over who had ever received a pneumococcal vaccination increased from 63.5% in 2015 to 67.3% in January–September 2016.

• The prevalence of obesity among U.S. adults aged 20 and over increased, from 19.4% in 1997 to 30.6% in January–September 2016.

• In the third quarter of 2016, 52.8% of U.S. adults aged 18 and over met the 2008 federal physical activity guidelines for aerobic activity (based on leisure-time activity). This was higher than the third quarter of 2015 estimate of 49.5%.

• The prevalence of current cigarette smoking among U.S. adults declined, from 24.7% in 1997 to 15.3% in 2015 and remained low through the third quarter of 2016 (15.9%).
• During January–September 2016, men were more likely to have had at least 1 heavy alcohol drinking day (31.6%) in the past year compared with women (18.6%).

• The prevalence of diagnosed diabetes among adults aged 18 and over increased, from 5.1% in 1997 to 9.2% in 2010, and has since remained stable through January–September 2016.


Q: What do the findings in this report tell us about the health of the country overall?

TC: Since 2010, the percentage of uninsured persons has decreased by almost 50% (16.0% vs 8.8%) and the percentage of persons who failed to obtain needed medical care due to cost has also shown a significant decline during the same time period (6.9% to 4.4%). These two indicators demonstrate increased access to healthcare from 2010 to September 2016.


Q: Are there any trends in this report that Americans should be concerned about?

TC: Although in the 3rd quarter of 2016, 52.8% of U.S. adults met the 2008 federal physical activity guidelines for aerobic activity; obesity is an epidemic that has seen a steady increase since 1997 and now affects just under one third (30.6%) of U.S. adults.


The Association of Marital Status and Offers of Employer-based Health Insurance for Employed Women Aged 27–64: United States, 2014–2015

January 12, 2017

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “The Association of Marital Status and Offers of Employer-based Health Insurance for Employed Women Aged 27–64: United States, 2014–2015

Q: Why did you decide to do a report comparing the marital status and offers of employer-based health insurance for employed women?

RC: A recent study found that women were less likely than men to have been insured through own employer and more likely to have been covered as a dependent. This report describes the association of marital status and the presence of employment-based insurance offers among employed women in the United States. It is important to note, that the presence of an offer does not necessarily indicated take-up.


Q: Is this the first time the National Health Interview Survey (NHIS) has released a report on this topic? If not, where is trend data available?

RC: This is the first time that NHIS has released a report on the association of marital status and of offers of employer-based private health insurance coverage for employed women.


Q: In general, how do offers of employer-based health insurance for employed women vary by marital status?

RC: Marital status is an important predictor of having an offer of health insurance through employment for employed women aged 27-64. Married women may gain an additional opportunity for an offer of health insurance coverage through their spouse’s employer. Therefore, taking all offers of health insurance into account, employed married women aged 27-64 were more likely than employed unmarried women to have an employer offer of health insurance.


Q: How do offers of employer-based health insurance vary by marital status for employed women within categories of educational attainment?

RC: Regardless of educational attainment, employed married women aged 27-64 were more likely than employed unmarried women to have been offered health insurance by their employer or their spouse’s employer. For both married and unmarried women, total health insurance offers increased as levels of educational attainment increased.


Q: Do offers of employer-based health insurance vary by marital status for employed women aged within categories of race and ethnicity?

RC: Employed non-Hispanic white and non-Hispanic Asian unmarried women were more likely than their married counterparts to have an offer of coverage from their own employer. However unmarried Hispanic and non-Hispanic black women were about as likely to have an offer of coverage from their own employer.


Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2016

November 3, 2016
Emily P. Zammitti

Emily P. Zammitti, M.P.H., Associate Service Fellow

Questions for Emily P. Zammitti, M.P.H., Associate Service Fellow and Lead Author on “Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2016

Q: Where do high-deductible private health insurance plans fit into 2016 estimates compared to earlier years?

EZ: Among private health insurance plans, high-deductible health plans have been increasing in recent years. 38.8% of persons under age 65 with private health insurance were enrolled in a high-deductible health plan in the first 6 months of 2016. This percentage has increased significantly, from 25.3% in 2010 and from 36.7% in 2015.


Q: What do you think is the most significant finding in your new study?

EZ: From January through June 2016, looking at adults aged 18 to 64, 12.4% were uninsured at the time of interview, 20.0% had public coverage, and 69.2% had private health insurance coverage. A small number of persons were covered by both public and private plans and were included in both categories, which is why the total does not always add up to exactly 100%. Among the 136.1 million adults in this age group with private coverage, 9.3 million or 4.7% were covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.


Q: What does your data show for young adult age groups who get private coverage through the Health Insurance Marketplace and state-based exchanges?

EZ: In our Health Insurance Early Release report, we provide some estimates of coverage among 19-25 year-olds, however, estimates of exchange coverage among young adults can be found in our quarterly tables, released as supplements to this report. Data from these tables show that nearly 2 million, or 3.5% of adults aged 18-29, have private health insurance coverage acquired through the Health Insurance Marketplace and state-based exchanges in the first 6 months of 2016. This percentage increased from 3.1% in the first quarter of 2016 to 3.9% in the second quarter of 2016. The supplementary tables can be found at https://www.cdc.gov/nchs/data/nhis/earlyrelease/quarterly_estimates_2010_2016_q12.pdf


Q: How have trends in health insurance coverage changed in 2016 compared to 2010 when the Affordable Care Act was established, and before 2010?

EZ: We can see a number of changes in health insurance coverage over time. In the first 6 months of 2016, 28.4 million (8.9%) persons of all ages were uninsured at the time of interview—20.2 million fewer persons than in 2010 (16.0%), but only 0.2 million fewer persons than in 2015 (9.1%). The difference in uninsured estimates between 2015 and the first 6 months of 2016 was not significant.


Q: What do you see in state-level estimates of health insurance coverage this year so far?

EZ: This report presents estimates of health insurance coverage for 12 states: California, Florida, Georgia, Illinois, Michigan, Minnesota, New York, North Carolina, Ohio, Pennsylvania, Texas, and Virginia. Of these 12 states, in the first 6 months of 2016, the percentage of adults aged 18-64 who were uninsured was highest in Texas (25.1%), and lowest in Minnesota (7.4%). Despite variation in the uninsured estimates between 2015 and the first 6 months of 2016, none of the changes for any of the 12 selected states were significant.


Health Care Access and Utilization Among Adults Aged 18–64, by Poverty Level: United States, 2013–2015

October 28, 2016
Brian Ward, Health Statistician

Brian Ward, Health Statistician

Michael Martinez, Health Statistician

Michael Martinez, Health Statistician

Questions for Michael Martinez and Brian Ward, Health Statisticians and Lead Authors on “Health Care Access and Utilization Among Adults Aged 18–64, by Poverty Level: United States, 2013–2015.”

Q: What findings in the report surprised you and why?

MM BW: We found it noteworthy that even though all adults aged 18-64 among all poverty level subgroups had decreases in the uninsured population from 2013 through 2015, only poor and near-poor adults had increases in the percentage that had a usual place to go for medical care and had seen or talked to a health professional in the past 12 months.


Q: How has the number of uninsured adults aged 18-64 by poverty level changed from 2013 to 2015?

MM BW: In 2013, 10.9 million poor, 13.2 million near-poor, and 15.2 million not-poor U.S. adults aged 18-64 were uninsured; in 2015, 6.6 million poor, 8.2 million near-poor, and 10.3 million not-poor U.S. adults aged 18-64 were uninsured.  There were 4.3 million fewer poor,  5 million fewer near-poor, and 4.9 million fewer near-poor uninsured adults aged 18-64 from 2013 through 2015.


Q: What did you find out from the percentage of adults aged 18-64 among all poverty level subgroups who did not obtain needed medical care due to cost?

MM BW: We observed that percentage of adults aged 18-64 who did not obtain needed medical care due to cost  decreased for all poverty level subgroups from 2013 through 2015, but the largest percentage point decreases were among poor adults, 4.2  percentage point decrease, and near-poor adults, 3.6 percentage point decrease, respectively.


Q: How do you determine federal poverty level?

MM BW: Federal poverty level was determined through a series of questions on the National Health Interview Survey (NHIS) to obtain family income. Federal poverty level was then determined by dividing the total family income by the U.S. Census Bureau’s poverty threshold specific to a family’s size and age of members in that family. This ratio is multiplied by 100, and family poverty level was determined based on where a family fell relative to certain thresholds. Adults were considered poor if their family poverty level fell below 100% of the threshold. Adults were determined to be near-poor if their family poverty level fell at or above 100% but less than 200%. And adults were considered not-poor if their family poverty level fell at or above 200%.


Q: What can you conclude from this report?

MM BW: We concluded from this report that despite improvements in health insurance coverage and health care access from 2013 through 2015 for poor and near-poor adults aged 18-64, they were still less likely than not-poor adults to have a usual place to go for medical care and to have seen or talked to a health professional in the past 12 months.


Health, United States Spotlight Infographics September 2016

September 21, 2016

hus_0916_screenshotHealth, United States Spotlights are infographics of selected health data available in Health, United States, the annual report on the health of the nation submitted by the Secretary of the Department of Health and Human Services to the President and Congress.

Each Spotlight displays approximately four health indicators allowing users to visualize and interpret complex information from different data systems and Health, United States subject areas.

This infographic features indicators from the report’s Health Care Expenditures & Payers subject area.

The full Health, United States reports are available at:http://www.cdc.gov/nchs/hus.htm


Health Insurance Data from the National Health Interview Survey

September 16, 2016

The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957 and collects data on a broad range of health topics through personal household interviews. NHIS has collected health insurance data periodically since 1959 and annually since 1989. The NHIS health insurance questions have changed and expanded over time to reflect changes in health insurance coverage as well as questionnaire design. Since 1997, the content and flow of the health insurance section has remained relatively stable, incorporating new programs where necessary. For example, new questions added in 2014 obtain information about whether coverage was obtained through the Federal Health Insurance Marketplace and state-based exchanges.

The NHIS allows for both point-in-time uninsured estimates as well as full-year and part-year uninsured estimates. Three estimates of lack of health insurance coverage are published for each calendar quarter: (a) uninsured at the time of interview, (b) uninsured at least part of the year prior to interview (which includes persons uninsured for more than a year), and (c) uninsured for more than a year at the time of interview. In addition, NHIS provides estimates of both public and private coverage as well as enrollment in high-deductible health plans and exchange-based coverage. The NHIS may be used to monitor changes in health insurance coverage throughout the year as the survey is fielded continuously throughout the year.

To see the latest quarterly numbers on health insurance coverage through January-March 2016, check out: Health Insurance Coverage: Estimates from the National Health Interview Survey, January-March 2016, released on September 7, 2016.